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ELECTRICAL PERMIT APPLICATION " <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 /� _ �6 _ 4 /j <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />LS�4127ti(G� <br />PROJECT ADDRESS <br />Owner Mail Address City Stale/Zip Phone <br />q2 <br />Tenant Mall Address City State/Zip Phone <br />Electrical Contractor Mail Address City Slate.'Zip Phone <br />c�as- .�3 z�633 <br />�2r' �e- *A q55 C K, <br />Slate License Number Contract Price of Work <br />� rC"%'t( <br />Proposed Use of Building Contact Persona (Plan Review) <br />Description of Work to Be Done: otz� P <br />f:JTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, NIC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not resume to give authority to <br />violate or cancel the provislons of any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perfomt the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature —Date <br />